In his Independence Day address, Prime Minister Narendra Modi referred to a recent report by the World Health Organization (WHO), which he said had stated that India’s cleanliness campaign had saved the lives of three lakh children.
In a statement issued earlier this month, the WHO did, in fact, shower praise on the Prime Minister’s pet Swachh Bharat Mission. It said India could avert 3 lakh deaths — provided there is 100% implementation of the cleanliness drive by October 2019.
This is what the WHO said: “WHO lauds India’s commitment to accelerated coverage of safe sanitation services which, assuming 100% coverage is achieved by October 2019, could avert up to 300,000 deaths due to diarrhoeal disease and protein-energy malnutrition (PEM) since the country launched the Swachh Bharat Mission in 2014.”
At the Red Fort Wednesday, the Prime Minister said: “Picchle dinon WHO ki report aayi hai aur WHO keh raha hai ki Bharat mein swachhta abhiyan ke kaaran 3 lakh bachche marne se bach gaye hain. Kaun Hindustani hoga jisko swachhta mein bhagidari ban karke in 3 lakh bachchon ki zindagi bachane ka punya paane ka awsar na mila ho. Gareeb ke 3 lakh bachchon ke zindagi bachana kitna bada manawata ka kaam hai. Duniya bhar ki sansthayein isko recognise kar rahi hain,” he said, according to the official Hindi transcript of his speech.
The official English version translated this as: “In a recent report the WHO has said that because of the cleanliness campaign three lakh children were saved. The credit for saving lives of three lakh children goes to every Indian who was a part of this campaign. Saving the lives of three lakh children of the poor is surely a great humanitarian act and the world bodies are recognizing it.”
According to the Swachh Bharat Mission website, the household latrine coverage figure for 2018-19 stands at 90.14% across the country. In Odisha it is 60.76%, in Bihar 63.32%, in Goa 76.22%, in Tripura 77.02%, and in Jharkhand 85.57%. On the other hand, states like Andhra Pradesh, Chhattisgarh and Arunachal Pradesh have 100% coverage. India has an annual birth cohort of 2.64 crore babies, and an infant mortality rate of 34 per 1,000 live births.
Parameswaran Iyer, Head of the Swachh Bharat Mission, told The Indian Express that the WHO study estimates that a cumulative 307,162 deaths will be avoided at 100% coverage of sanitation. “Rural India is at 90% coverage today. Besides, there are also other health impacts of Swachh Bharat that go beyond impact of access to toilets,” he said.
Iyer quoted an excerpt from the WHO report that said: “Calculations are for health impacts from improvements in sanitation coverage. It is possible that the Swachh Bharat Mission led to additional health gains through changes in personal hygiene (e.g., handwashing behaviour) and consumption of safe drinking water (e.g., reduced risk of faecal contamination of drinking water). Had the different scenarios considered the health impacts from hygiene and drinking water, estimated health impacts would be larger. There is evidence that improvements in drinking water supply, sanitation services and personal hygiene have positive health impacts, e.g., improved nutritional status and its benefits, reduced incidence of infectious diseases such as different neglected tropical diseases and acute respiratory infections in addition to reductions in diarrhoeal disease. Therefore, it is possible that the Swachh Bharat Mission has contributed to additional health impacts, which are not quantified in this assessment.”
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The report then, by WHO’s own disclaimer, was an underestimation of the life-saving impact of the Swachh Bharat Mission, Iyer said. “Accounting for this, the estimated number of lives saved by now would be approximately 3 lakh as per the PM’s statement made from the ramparts of the Red Fort today,” he said.
The WHO statement was based on the initial results of a WHO modelling study on the health impact of the Swachh Bharat Mission Gramin (SBM-G). The WHO analysed that India’s accelerated coverage of safe sanitation services, and its determination to end open defecation, would have a substantial effect on the burden of diarrhoeal disease and PEM by reducing mortality and accumulative Disability Adjusted Life Years (DALYs) — the sum of the years of life lost due to premature mortality and years lost due to disability or ill-health.
Data for the study come from two large nationally representative surveys: the Rapid Survey on Children, which was made shortly before the launch of the SBM in 2014, and the National Family Health Survey from 2015/2016. This modelling study uses data from third party surveys as well as SBM-G administrative reporting, and its targets up to October 2019.
According to the calculations, if all sanitation services are used, the initiative could result in over 14 million more years of healthy life in the period measured, with the benefits accruing yearly thereafter. That, WHO said, is especially remarkable given that before 2014, unsafe sanitation caused an estimated 199 million cases of diarrhoea annually, with modelling showing the problem will almost be eliminated when universal use of safe sanitation facilities is achieved.
Household sanitation coverage has increased from an estimated 2% per year before Swachh Bharat to more than 13% annually between 2016 and 2018. However, most of the WHO statement talks about the benefits of the sanitation programme in the future tense.